Finance/RCM (117)

New artificial intelligence models have unpredictable consumption-based costs, says Rhett Alden, Elsevier's CTO of health markets. But "all you can eat models" and inclusive pricing can avoid the need for clinicians to meter tool use.

The underlying challenge is how to fund an industry that's very important but is also perpetually on the brink of bankruptcy, says Kunal Sarda, CEO of Arya Health.

It's a struggle to provide an explanation and clarity on why a claim was denied with the level of detail required, says Fawad Butt, CEO at Penguin Ai.

To get ROI, execs need to apply technology at scale, says former HCA CFO Bill Rutherford, who is now on the Board of Mangers at Ensemble Health Partners.

New U.S. Department of Labor rule would have an immediate positive effect on pharmacies and negatively impact the big Pharmacy Benefit Managers (PBMs), says Dae Y. Lee, attorney at Buchanan Ingersoll & Rooney.

Omega Healthcare works with hospitals on rev cycle tools, making tweaks in such areas as data and population that make each provider unique, says CEO Anurag Mehta.

MedeAnalytics, Socially Determined and Mathematica collaborated to give a Southern health plan of 1 million members the data to save $25 million through SDOH interventions, says Saleem Tahir, COO of MedeAnalytics.

There are challenges experienced by providers during payer negotiations, and various tech capabilities needed to build the most effective and valuable payer negotiation tech stacks. Dilpreet Sahota, founder and CEO of Trek Health, explains.

Patient visit documentation must accurately reflect the clinical reality of patient care to serve care coordination and timely reimbursement, according to Dr. Sari Green, physician executive director at Accuity.

TEMPO and ACCESS are two new models that signal a large change in how the federal government intends to govern cost, quality and accountability in Medicare. Bill Charnetski, government affairs pro at PointClickCare, offers a deep dive.

AI plays a role in patient engagement because it’s critical for clinical efficiency, but it doesn’t replace functions, says Matt Fisher, VP of operations at Curae.

Provider frustration over prior authorization is real but doesn't tell the whole story of the patient journey, says Brian Smith, chief pharmacy officer at Shields Health Solutions.